Dec. 01--Michael Holtz thinks he knows what it would have cost him to not have insurance when he was diagnosed with stage 4 colorectal cancer more than five years ago:

His life.

Holtz, now lead ambassador for Tennessee for the American Cancer Society's Cancer Action Network advocacy group, spoke briefly Thursday morning at a small rally calling for legislators to vote "no" on health care repeal in the proposed tax reform legislation.

The U.S. Senate might vote as early as Thursday night or Friday morning on the bills, which several organizations say will increase health care costs and limit access, especially among the most vulnerable, such as senior citizens and cancer patients.

Higher costs, less coverage?

Holtz has a list of reasons he said the Senate bill, as it currently is written, could harm those battling cancer and other terminal illnesses. First, it repeals the individual mandate that requires Americans, with few exceptions, to carry health insurance.

"Repealing the individual mandate would significantly weaken the individual insurance market, leading to higher premiums, fewer choices and more uninsured Americans," said Holtz, citing a report from the Congressional Budget Office that estimated eliminating the requirement from law would lead to 13 million more uninsured Americans.

Second, it could increase insurance premiums by 10 percent or more, the CBO report said -- which would hit cancer patients, who likely are already paying more for drugs and treatments, harder.

Not having health insurance to get him to remission would have financially "destroyed" his family, Holtz said.

"Survivors can't afford losing access to care," he said.

Holtz said there are about 300,000 cancer survivors in Tennessee. It's unclear how many use the Affordable Care Act marketplace to buy insurance. More than 234,000 enrolled in marketplace plans for 2017, but the government does not track diagnoses among enrollees.

Early diagnosis, treatment is key

Research suggests uninsured patients are more likely than insured to be diagnosed in a later stage of cancer, increasing the cost of their care and decreasing their survival rates.

Marketplace coverage hasn't been perfect; some patients have complained of exorbitant out-of-pocket costs that force them to decide whether they can afford particular treatment, and others have complained that several nationally known cancer treatment centers weren't in network.

But the ACA, as it's currently written, does protect cancer survivors from being refused insurance policies based on "pre-existing conditions," as happened routinely before the law was passed.

Prostate cancer survivor and ACA advocate Rich Henighan, a nurse practitioner, said he had "very good coverage" during his diagnosis and treatment. Six years later, he's retired from that job and relies on Medicare to pay for his follow-up screenings. He's worried proposed cuts to Medicare might affect coverage of those for himself and others.

The ACA as it now stands requires policies to cover 100 percent of certain preventive care, including some cancer screenings. Henighan said his prostate cancer was diagnosed in a routine annual screening.

"One year it wasn't there, the next year it was," he said. Because of the annual screening, recommended for his age, "they caught it early, and so far treatment has been effective."